Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London

Abstract

Background: Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust's endometriosis database. Results: One hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3-6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions: Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

Vault Endometriosis: Detailed Step-by-Step Laparoscopic Surgical Management Technique

“…7 Medical management was not efficacious in our patients as elicited by the clinical history, which corresponded with the findings of other studies in the literature. 19 Moreover, prolonged and unguided medical management may lead to tissue fibrosis which further makes the surgery technically demanding. Some of the review articles have documented the role of imaging in the pre-operative diagnosis, but no definite features suggestive of vault endometriosis has been specified.…”

Intestinal Endometriosis Leading to Recurrent Hematochezia

“…In uncomplicated cases, medications that downregulate estrogen levels, such as oral contraceptive pills, gonadotropin-releasing hormone agonists, danazol, or progestins, have been shown to improve quality of life. 8 In severe cases where patients fail hormonal treatment or in patients who no longer want children but are of reproductive age, a total hysterectomy with bilateral oophorectomy may be preferred, 9 particularly if they present with complications such as severe bleeding, bowel obstruction, or concern for malignancy.…”

“…7 It has been shown that quality of life is comparable with medical and surgical treatment. 8 Nonetheless, only invasive treatments can fully eradicate the endometrial foci. In uncomplicated cases, medications that downregulate estrogen levels, such as oral contraceptive pills, gonadotropin-releasing hormone agonists, danazol, or progestins, have been shown to improve quality of life.…”

Catamenial rectal bleeding due to invasive endometriosis: a case report

“…Treatment of endometriosis is dependent on the severity of the disease. Studies show that patient quality of life and satisfaction rates are comparable with medical and surgical treatment [17]. Medication treatment offers success in early uncomplicated cases and includes oral contraceptive pills, progestins, danazol, and gonadotropin-releasing hormone (GnRH) agonists.…”